Quantitative Assessment of Seminoma in the Testicle Among Nonseminomatous Germ Cell Tumor Patients on Operative Difficulty, Morbidity and Pathological Outcomes at Postchemotherapy RPLND

OBJECTIVE: To determine how the quantitative assessment of seminoma in the orchiectomy specimen adds to surgical complexity and morbidity of PC-RPLND for nonseminomatous germ cell tumors (NSGCT) and its influence on incidence of necrosis.

METHODS: Patients with seminoma as a component of NSGCT in the orchiectomy specimen who underwent PC-RPLND at Indiana University from 2013 to 2019 were identified to assess intra-operative, postoperative, and pathologic findings.

RESULTS: Of 677 PC-RPLND patients, 109 contained seminoma elements in the orchiectomy specimen. The probability of performing additional intra-operative procedures to achieve complete resection and estimated blood loss during PC-RPLND increased with higher seminoma percentage. On multivariable logistic regression, patients with > 75% seminoma in the orchiectomy specimen had 12 times higher odds of requiring additional intra-operative procedures when compared to those with ≤ 25% seminoma in the orchiectomy specimen (P = .005), irrespective of retroperitoneal mass size or postchemotherapy size reduction. Postoperative outcomes remained similar. As percent seminoma increased by quartile, necrosis was more prevalent (23.7%, 25%, 33.3%, 41.7%).

CONCLUSIONS: Surgical difficulty and need for intra-operative procedures for complete disease resection can be better predicted with higher percent seminoma in the primary tumor. The percentage of seminoma in the primary tumor does not predict necrosis sufficiently to exclude PC-RPLND. This understanding is important for improved patient counseling and preoperative planning.